We feel the following trends in the use of the tranquilizing drugs should be checked. First, patients should not receive a tranquilizing drug without proper physical and mental examination. We know that some of the drugs can lead to physical complications and therefore the physical status of the patient at the beginning of medication is of importance. Complications are known to develop with chlorpromazine and reserpine. We have less knowledge about complications concerning the milder tranquilizing drugs, but we do not believe that we can state at present that no complications can develop and that they are harmless. It is unwise to claim on the one hand that these different compounds ire highly effective and exert specified actions on the nervous system and other parts of the body, and on the other hand try at the same time to convey the idea that they are completely harmless agents, which in their chemical action are similar to a placebo. No chemical compound effective in the realm of psychiatric disorders can be considered completely harmless for the simple reason that these drugs not only produce physical symptoms, but can also produce emotional symptoms. The physical symptoms are those which are usually the most conspicuous. Therefore, we have known for some time what physical side-effects can be produced by chlorpromazine or by the Rauwolfia compounds. It was only later that we became aware of the fact that in some patients these compounds produce undesirable emotional states, instead of relieving them. In a paper dealing with the effect of chlorpromazine on moderate and mild emotional disturbances we have indicated that at times emotional complications may occur. The same is true with the use of the Rauwolfia preparations. Actually far more cases of depression occurring during Rauwolfia medication were reported by reliable investigators than with the other compounds. We do not know enough about the milder tranquilizing compounds like meprobamate which are used in the milder emotional disorders. We also do not know if psychic complications occur with any frequency or not.

Second, we believe that if a tranquilizing drug is prescribed, a proper indication for its use should be present. In other words, it should not become a reflex panacea, meaning that any and every kind of nervous and emotional complaint should be treated by giving one or another of the tranquilizing drugs. It would be deplorable if the emotional complaints of the patient were not assessed and properly evaluated, and if all forms and kinds of emotional disorders regardless of how they occur, in what configuration they manifest themselves, and what causes are behind them, would be treated by the administration of a tranquilizing drug.

Another difficulty which we frequently encounter is that the patient is not kept under close enough medical surveillance as to what mental and physical symptoms he may develop under the influence of these drugs. The first few weeks of treatment with these drugs are a crucial time and frequent observation of the patient is essential. We have seen patients develop depressions who were told to take the medication and to return in two or three weeks, with the assumption that the drug would either help or not help, but that it could not produce undesirable effects. Many physicians are aware of some of the physical complications which can be produced by these drugs, but are far less aware of the mental alterations which can be observed. Fortunately, in the majority of the patients there is an amelioration, but in some there is an aggravation, of the existing symptomatology and sometimes even new symptoms occur.

A patient who is using the drug on a maintenance dosage level does not have to be seen as frequently as a patient still under full treatment. However, even patients who are on a maintenance dose should be seen every few weeks to determine whether or not the drug still controls the symptoms, whether the amount given can be reduced, or even if the drug can be withdrawn. It is also important to decide whether the patient will or will not require psychiatric help in addition to the drug treatment.

Related posts:

1. Drug Therapy in Psychiatry. Part 2 Most of the reliable information on the action of these compounds relates to psychotic patients. A considerable literature also exists on then-use in neurotic patients. However, the interpretation of data with these patients is far less reliable than with psychotic patients. The oral use...
2. Drug Therapy in Psychiatry. Part 1 October 17, 1956 We should like to discuss several aspects of the problem from a clinical point of view, namely, what kind of drugs should be selected for treatment, indications for the use of tranquilizing drugs, the question of dosages, and how long treatment...
3. Drug Therapy in Psychiatry. Part 4 The drugs, of course, are used not only in psychotic patients but in many neurotic patients. The tranquilizing drugs are prescribed in large quantities outside of mental hospitals and practically every physician today prescribes these drugs to patients when he assumes that some emotional...
4. Drug Therapy in Psychiatry. Part 5 We would also like to emphasize that it is much more difficult to establish the maintenance dose of the patient than the primary therapeutic dose. We all use maintenance dosages and for the patient who has been on the drug for a few weeks...
5. Drug Therapy in Psychiatry. Part 8 Observations obtained from carefully studied individual cases and from mass experiments would indicate that the tranquilizing drugs act by suppressing the patient’s symptomatology. They suppress certain clinical manifestations in the patient in the same way as an anti-epileptic drug suppresses epileptic discharges. From a...